Healthcare Provider Details

I. General information

NPI: 1396156055
Provider Name (Legal Business Name): SAAD MUMTAZ HASAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 AUBURN AVE STE 201
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

2123 AUBURN AVE STE 201
CINCINNATI OH
45219-2906
US

V. Phone/Fax

Practice location:
  • Phone: 513-206-1170
  • Fax: 513-206-1172
Mailing address:
  • Phone: 216-444-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number35139586
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: